Acute low back pain - does anything help?

Loretta Marron OAM BSc

From a Skeptics Perspective: Loretta Marron, a science graduate with a business background, was Australian Skeptic of the Year for 2007 and in 2011. She is the Chief Executive Officer of the Friends of Science in Medicine and that organisation won Australian Skeptic of the Year for 2012. On Australia Day 2014 she was awarded the Medal of the Order of Australia (OAM ) for "service to community health" Loretta edits the websites www.healthinformation.com.au & www.scienceinmedicine.org.au

Most of us experience low back pain (LBP). When it persists, we look for ways to alleviate it. In Australia, back problems are the most frequently seen musculoskeletal condition by General Practitioners (GPs) and the seventh most common reason for seeking care. National guidelines[2] from the UK suggest that patients should try acupuncture, manual therapy or an exercise program. A range of medical devices are promoted for pain relief. Are they all placebo treatments or do some work?

A 2001 "cost-of-illness" study[3] of Australian adults with LBP estimated the direct cost to be over $1 billion with more than 70% spent on acupuncturists, chiropractors, general practitioners, massage therapists and physiotherapists. Adding to that $8.15 billion in indirect costs, such as time off work, the total comes to $9.17 billion. LBP is not just a massive health problem, but also a significant economic burden.

'Acute' is defined as being present for less than three months, (longer than that is defined as 'chronic'). For 95% of people, the cause of acute LBT is not found, the problem is self-limiting, with most recovering within three months. Serious spinal conditions are rare.

Many interventions are claimed to help, but the news from research is not good.

Acupuncture is touted as having been used for "2,000 years to alleviate back pain". However, a recent meta-analysis[4] of 13 randomised controlled trialsconcluded that it was a placebo. It provided some relief, "likely to be produced by the nonspecific effects of manipulation".